If you work in healthcare you can’t have missed the recent outrage around government intentions to move the NHS to a ‘7 day service’. Thousands of people have signed a petition calling for a vote of no confidence in health secretary Jeremy Hunt. Mr Hunt hasn’t endeared himself to me, moly sorting from the point where he tried to shut Lewisham Hospital, a recently renovated site that serves a huge population of South Londoners and was noticeably not failing. Following public outrage and months of protest around the legality (not to mention ethics of making hundreds of sick people travel an hour to another busy A&E department when there’s a decent one nearby), the plans were reversed and Lewisham H still stands.
A 7 day health service is a good idea. People don’t just get sick on working hours and we need to accommodate them, not the other way around. But it’s also not a revolutionary idea. I don’t know if you’ve been to a hospital on a weekend. I have and I can assure you it’s still open. Doctors and nurses work long hospital shifts around the clock every day of the year. It is a fallacy to suggest that they don’t or won’t work weekends – they rarely have a choice. Walk in centres are open weekends, and many GPSs offer a Saturday clinic. Mental health crisis teams cover weekends, keeping people in great distress safe and out of hospital. But Friday night is still not a great time to get ill. Whilst NHS staff do work weekends, it’s usually not the full working force that you’d get on a weekday. Additionally, doctors don’t work in isolation. There work depends on other staff, many of whom do not work weekends. Discharges may face a length delay whilst waiting for assessment from a social worker, occupational therapist or physiotherapist. Scans and tests need to be carried out an analysed. If transferring to another team then liaison is needed, and administrative staff for all the records and associated paperwork. A 7 day service is needed from all staff to keep the operation working.
As a psychologist I have a pretty good deal regarding working hours. I usually work 9-5 Monday to Friday. In my current setting this actually makes sense, I work in rehabilitation and we operate a structured rehab program that mirrors attending a job or course. Therapy sessions occur during the day with breaks, evenings and weekends are left free for leisure activities, family visits and relaxing. The service is residential so clients are available in the daytime for sessions. The unit operates 24/7 and as a senior clinician I also take part in an ‘on call’ system. This isn’t comparable to the kind of on call doctors engage in – I take a phone home about 6 nights a month and am available to give guidance to night staff if needed. Sometimes I’m woken up in the middle of the night but mostly it’s not much hardship. I will work weekends if needed, as sometimes this is the only time family work is possible but most of the time I have pretty ordinary hours, much the envy of my doctor friends.
I like working 9-5. It’s a predictable, regular routine. It’s sociable – I’m off work when my friends and family are, making weekend plans is pretty easy. It’s comfy and to be honest I’d like to stay working 9-5, it suits my life. But I can see that I need to be flexible and I’m not adverse to it. In training I worked an evening therapy clinic and found it quite peaceful working in the evening. I mostly saw clients who worked and they appreciated the opportunity. Given the push to get people back into work as a marker of ‘good mental health’ it makes no sense that we then disrupt their working day to come to appointments. Mental health obeys no working week and nights and holidays can be times when people particularly need support.
When I worked in a stroke rehab team we began running a Saturday service in recognition that people coming in to hospital later in the week were getting a worse deal in acute rehab (especially for something like a stroke where early days are very important). It was a briefer service (each staff member worked one Saturday in 7) but it made a difference. Admittedly, with fewer professionals on the ward it was a much calmer atmosphere on a Saturday so it was possible to get a lot done!
Psychologists usually aren’t a crisis service. When someone’s in the midst of a distressing episode they often need containment and support to stay safe, it’s not the time to start exploring things. This kind of support can come from many different professionals. There’s usually not a call for therapy to be provided at 2am (although I believe in some models such as MST the therapist does make themselves available through the night). However psychologists may be needed for assessments (e.g. risk, capacity, cognitive) at all sorts of times, and without them treatment and transfer may be delayed. Additionally, staff support may be needed 24/7 and we need to ensure that staff who work nights don’t miss out on support and also the training that psychologists might provide. It’s also important that we show willingness to adjust our hours as this can be a point of resentment in a team. Everyone has a life and commitments out of work, everyone misses out on something because of their work hours and everyone has an important role to play.
So it’s time to give up our cushy 9-5, as much as we love it. We’re public servants and we’re needed out-of-hours. We need to stand beside our doctor and nurse colleagues, healthcare should be holistic but that can’t be the case if only part of the MDT is in work.
Motivation alone won’t be enough to get us to a 24/7 health service. Evening and weekend staff need to be funded. I can do a weekend or evening clinic, but I have a full caseload and I’ll be taking away from the work in do on other days (not to mention missing meetings and other events). I can make my service more accessible but I can’t fit more work into the same number of hours. Hiring more staff to cover ‘out of hours’ times should be cost-effective in the long-run. It should speed up treatment and discharge and limit deterioration as people wait to see a professional. It could support staff by reducing the Monday morning backlog and lengthy weekend handover, as well as hopefully improving patients’ confidence in the healthcare system. Obviously some consideration will need to be given to those with children, care and similar commitments for whom it may be tricky to be flexible. 9-5 is comfy but it ultimately isn’t fair, on patients or the staff who are left behind. Health and wellbeing is a challenge for every hour of the day and we need to rise to that.